If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program

Ann C. Klassen, Ann L M Smith, Helen I. Meissner, James Zabora, Barbara Curbow, Jeanne Mandelblatt

Research output: Contribution to journalArticle

Abstract

Background. Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues. Methods. We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 11/2 h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community. Results. Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have >$10,000 annual income (OR = 2.34, 95% CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95% CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95% CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95% CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95% CI 1.52,8.60). Conclusions. Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.

Original languageEnglish (US)
Pages (from-to)13-21
Number of pages9
JournalPreventive Medicine
Volume34
Issue number1
DOIs
StatePublished - 2002

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Early Detection of Cancer
Breast Neoplasms
Costs and Cost Analysis
Primary Health Care
Interviews
Baltimore
Mammography
Poverty
Health Insurance
African Americans
Case-Control Studies
Multivariate Analysis
History
Psychology
Health
Neoplasms

Keywords

  • Breast cancer screening
  • Evaluation
  • Intervention
  • Low income
  • Mammography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program. / Klassen, Ann C.; Smith, Ann L M; Meissner, Helen I.; Zabora, James; Curbow, Barbara; Mandelblatt, Jeanne.

In: Preventive Medicine, Vol. 34, No. 1, 2002, p. 13-21.

Research output: Contribution to journalArticle

Klassen, Ann C. ; Smith, Ann L M ; Meissner, Helen I. ; Zabora, James ; Curbow, Barbara ; Mandelblatt, Jeanne. / If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program. In: Preventive Medicine. 2002 ; Vol. 34, No. 1. pp. 13-21.
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abstract = "Background. Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues. Methods. We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 11/2 h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community. Results. Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have >$10,000 annual income (OR = 2.34, 95{\%} CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95{\%} CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95{\%} CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95{\%} CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95{\%} CI 1.52,8.60). Conclusions. Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.",
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